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Unformatted text preview: 1 To: From: Date: Subject: The Class of 2007 Rich Levitt February, 2005 STEP I Preparation (Lots of what you might want to know!) Many years ago a wise student wrote this recommendation on a Survey of Step I for the following year’s class: “Make a plan, then work the plan.” Over the years, nothing else has carried as much weight as this!! A plan will bring you some peace of mind, for if it is well put together everything will have a place. This will allow you to focus on each day at a time without becoming unduly anxious about areas you haven’t covered yet. Probably nobody will have a perfect plan–>some things will take more time & other things less time than planned. Be flexible! Writing your schedule plan in pencil helps to support flexibility (as you can easily add, remove and replace scheduled items). _______________________________________________________________ For Starters: The CBSSA Mock Exam This Comprehensive Basic Science Self-Assessment exam is a series of 4 blocks of 50 questions retired from the question bank of USMLE Step 1. It provides a profile of 19 disciplines and systems in essentially the same format as that which you would receive after taking the real Step 1. Of far less importance, the profile comes with a standardized score of Mean=500, SD=100. Step 1 uses a different standard score; it is, approximately, Mean=217, SD=23. The CBSSA Profile is presented in bars rather than numbers. This is so because most questions will draw from knowledge in more than one area (e.g., a question on statin drugs will at least relate to both pharmacology and cardiology). Since you will take the CBSSA before you really study for Step 1 the only real value of the score is to motivate your study! ((Last year’s approximate Mean was about 340, and SD about 65)). Your CBSSA is likely to provide you with the best profile of your strengths and weaknesses relative to the national sample of takers of Step 1 in previous years, and thus provide you with insight into the amount of time you may want to plan to devote to your discipline &/ or system 1 review areas. For example, if Physiology, GI and Renal were the lowest/weakest on your profile, you would want to put extra time/effort into GI and Renal Physiology. Of course you should feel free to consult with me if you are uncertain about how to implement your profile into your study plan. You can understand that this profile will allow you to determine how to get “the most bang for the buck” with the “buck” being time and effort. Although you can take this initial CBSSA either timed or untimed...it is strongly recommended that you take it untimed, for your purpose early on is to determine the relative strengths & weaknesses in your knowledge base for your long term study plan; taking it in a timed format will not add to your insights into your knowledge base, and at worst will confuse measures of your knowledge, speed of access to your knowledge, and test taking skills and test taking strategy. Concern yourself with timing near the end of your study plan. You can spend as much as 4 hours per block of 50 questions in the untimed mode, and you can take those 4 blocks one at a time over a period of days. The medical school will pay for your initial CBSSA; you will be given a login code sometime in March. The CBSSA provides a second equivalent form for your payment of $45. You might consider taking this second form a week or 10 days short of your scheduled USMLE date. At this late point you would take it as a timed exam as it can then reflect your readiness for your testing (according to your personal goal), identify the discipline(s) or system(s) which can give you “the most bang for the buck” during your last study week, and as a timed exam it would train (set) your nervous system with some memory trace of the pace you will need to work at to complete a block of 50 questions in an hour or less. The USMLE also provides a shorter free sample test that you can use to check your timing/work pace a day or two before your test date. Since the school will be paying for your CBSSA this year at the beginning of the Step 1 Study Period, I will be doing the class statistics for use next year, as well as continuing to identify students with the most measurably productive study plan to meet with the class of 2008 next January (as Nicole, Cory and Adib did this year). In line with this I ask you to please provide me with your CBSSA score(s) and the date it is provided to you on the web; and of course bring your profile with you if you will be meeting with me to work out a study plan. If you will not be meeting with me please e-mail to me your CBSSA score along with the date you took it for my data statistics.. If you take the CBSSA after meeting with me to work out a study schedule, and you would like to meet again to examine/discuss with me your schedule in light of your CBSSA profile, please do not hesitate to request to do so. _______________________________________________________________ The thoughts and information that follow can help to structure your thinking towards creating your plan. Use it as a sort of template. 2 A Study Plan: General Considerations For a Review Plan Discipline vs System-based Review Over the last several years most students have worked with a (‘modified’) discipline approach, the general structure of which follows. Essentially, time is scheduled to review one basic science discipline at a time (Pharm is usually an exception...more on this shortly); disciplines include: Anatomy (anatomy includes gross, histo/cell bio, embryo, neuro), Biochemistry (includes molec. metabolism, nutrition), Behavioral Science (includes psych., Dr-Patient & biostat/epi), Microbiology & Immunology, Physiology, Pathology, Pharmacology, and Genetics not covered previously in Biochem and Path (eg., population genetics). These inclusions conform to the sections in First Aid, and the “Performance Profile” provided by the USMLE to examinees as a part of an individual’s score report, both for Step 1 and the CBSSA. As noted above, the USMLE also provides systems as well as disciplines in the profile reported with your Step 1 score. The sections in Step Up conform to the profile’s organ systems. Pharm, Micro/Immuno and especially Path (with Pathophysiology) are commonly disproportionately highly represented disciplines; there is more disparity among proportional system representation between test takers. The approaches that have predominated for the heavy-rote-memory pharm are heavily connected to First Aid and the Survey from last year’s MS2s, use up-to-date (2003 or later) resources, & focus on mechanisms, interactions & toxicities). Whatever pharm approach used, keep in mind that spaced repetition produces the best memory for rote memory information. Pharm Planning (in no preferred order): 1.) Use the PharmCards &/or First Aid from day one; memorize a few drugs in the same class per day (perhaps first thing in the morning), & then go over each class again when reviewing the relevant system or discipline pathophysiology (e.g., Cardio or Cardio Path), or the common disciplines (e.g., Behavioral’s CNS drugs and Micro’s antimicrobials & Immuno’s anti-rejection drugs), and review all drugs again in the last week or so of your review. If you use the Pharm Cards: 1.) Organize! Use the PharmCards with each respective functional area sectioned (eg., rubberband the CNS drugs with behavioral science, the organ system drugs with the pathophysiology of each system respectively, etc.). Some may want to create their own drug charts with 4 columns for: the drug name, mechanism, interactions and toxicities. 2.) Place a mark on those drug cards which are also in First Aid and additionally mark those 3 cards which are also in Katzung & Trevor’s “Key Drugs” chapter in Pharmacology (available in Book Room folder). So, for example, each card might have either an “F” for First Aid, or a “K” for Katzung, or both F & K, or no marks. Then, within each functional area organize the cards so that those drugs which have both “F” and “K” marks are on top, those with either “F” or “K” beneath in the area, and those with no letters will be at the bottom of the cards of that area. Finally, check the Survey’s Pharm section to see if any unmarked drug should be marked. This will assure that those drugs most likely to be on your test are always seen first when you review that area; this provides “the most bang for the buck” in pharm. 4.) General pharm (kinetics, metabolism, dynamics, regulation, etc) can be reviewed at any point between disciplines or systems in your schedule using Lippincott or whatever you used last year &/or feel comfortable with; this can be a useful ‘brain break’. Of note-Few students have tried to study pharm as an isolated discipline (like Biochem or Physiology) and none have recommended it (it would be a truly daunting task for your brain’s ‘hard drive’!). Scheduling your Sequence of Disciplines Generally there are 3 major issues often considered in sequencing the disciplines for a study/review schedule– 1.) if a faculty review you would attend is scheduled and when it is scheduled--you would ideally want to try to place as many of your discipline reviews as is practical around the time of the faculty reviews for concentrated focus & memory reinforcement (Biochem will be the first review this year) 2.) if a discipline naturally connects to another in sequence (e.g., physiology naturally precedes pathophysiology)-3.) try to distribute the more conceptual/less memory intensive disciplines (such as behavioral science and physiology) so that they act as a sort of change-of-pace (e.g., you might put behavioral science or general pharm between biochem and micro/pharm). Scheduling the sequence within a discipline The general sequence within each discipline may best be broken down to 6 steps: 1.) preview the high-yield facts in First Aid & Survey (& Step Up if a system approach) for each portion of the discipline or system about to be reviewed (e.g., carbohydrate metabolism or cardiophysiology), 2.) review each portion of the discipline with special attention of content recognized from First Aid’s high-yield facts & the Survey (& Step Up). 3.) do practice questions (20-30 mcqs) on that portion (usually in Q-Bank); read the explanations even for those questions answered correctly. 4.) note errors in knowledge/memory in your First Aid or Step Up book (write or underline or highlight, etc.). After all areas of a discipline/system are completed... 4 5.) review First Aid’s/Survey/Step Up section again to be sure all was covered; look up in an alternate resource any high yield information not covered in your review resource and with which you are not confident. 6.) then do an integrated discipline test, note errors in knowledge in your First Aid or Step Up, 7.) and finally move on to your next discipline or system. Schedule plans Using a Systems Approach (SA) With a SA you will be reviewing perhaps 9 systems plus doing some reviews necessarily by discipline (eg., biochem, behavioral science & micro/immuno). The availability of Step 1 resources for a comprehensive SA doesn’t leave much choice. The only comprehensive printed SA review materials (besides Step Up) are those that have been provided through Kaplan over the past few years. In addition to Q-Bank the Board Simulator Series (BSS) provides SA practice questions (which are more difficult than real board MCQs). These test questions are grouped to include 3 or 4 systems per test (e.g., BSS tests in Book 3 integrate nervous, skin/connective tissue & musculoskeletal system questions), so you will want to sequence your system reviews accordingly if you want to use the BSS questions throughout instead of just after you finish all of the systems. Beware–because the BSS questions are overall notably harder than those on the Boards, do not let your lower than normal score sap your confidence—the more you miss the more you learn from your errors! If you find that you cannot control this internal confidence issue with BSS, don’t use BSS! (Scores on BSS exams are often in the 50% range). Step Up (Second Edition only) is a kind of First Aid (high-yield info) in a systems rather than discipline format; as such, it appears to be best used like First Aid (& the Survey) to start your review of each system (to be able to recognize the high-yield info during your review), to complete your review of each system (after you finished your review–>to be sure you covered all of the high-yield info), and then later as a memory check a week or 2 before your test date. It would be the SA source for condensing resources (making notes) as First Aid is for disciplines. Whenever possible use both First Aid & Step Up for determining the ‘High Yield Facts’! A thorough SA can be quite effectively accomplished by working with a variety of materials together...e.g, for renal, look over Netter, then read the renal chapter in BRS Physio, then look at some histo pictures in a (perhaps Wheater’s) histo atlas, maybe some renal in Langman’s or HiYield Embryo, then the renal chapter in BRS PATH along with the renal drugs in PharmCards or First Aid, WebPath’s renal pictures and practice MCQs, etc. If you use Q Bank you can easily do additional renal questions by discipline after each of the aforementioned materials). It can be a bit awkward carrying and integrating all of these materials, but it will be a comprehensive review. 5 If you want to use the comprehensive/integrated discipline-based questions such as those at the end of say BRS Physiology...or Appleton & Lange’s Review for USMLE Step 1 (for extra practice beyond Q-Bank), as they are presented by discipline... you would of course wait until you completed all of the organ systems (or just Behavioral or Micro or Immuno). Within the approach you use you will have to work out the level of scheduling detail you will be comfortable with. Although a Plan appears to be necessary for everyone, the format and level of detail of that plan may differ significantly from person to person (“...different strokes...”). For 3 examples: 1.) one student may only want to schedule 7 days for physiology-2.) another will want to schedule 2 chapters a day in, say BRS Physiology-3.) a third student will want to schedule, in detail, Cell Physio from 3:00-6:00 p.m., dinner from 6:00-7:30 p.m., Cell Phys questions from 7:30-9:00 PM., etc. (you get the idea!) Next, it is a good idea to begin to pencil in a schedule. Timelines* * This is about a 10-week plan, from April 18th (starting with ICS) and running until about June 25th, expand or contract it to fit your scheduled test date and whether you plan to start studying over Spring Break 1.Allow an average of a week (6 days = 1 week) for each discipline (2 weeks for Path, maybe 10 days for Micro & Immuno) beginning with the ICS course. This is based on studying an average 8-9 hours/ most ICS weekdays, the equivalent of a day off most weeks–except for Cory Study-Alikes! ( a whole day, or parts of 2 or 3 days off), and the equivalent of a 12-hour weekend day. Once ICS ends, a 12-hour weekday is the same as 1.5 days during ICS. Add time to your weaker &/or the higher-yield areas, & reduce time for your strong &/or lower-yield areas. This will provide you with about 7-8 weeks of discipline review, and 2-3 weeks or so (depending upon your test date) for integrative practice, special attention to your weaker areas, further review in First Aid (discipline-based) & Step up? (System-based), additional rote memory repetition (to drugs/bugs, etc.), practice testing, and finally, a brief stint with the USMLE’s Tutorial and sample/practice questions. 2. Start to fill in your calendar (create one, buyone, use a PDA, or make copies from one of the weekly calendar sheets you can pick up in the Book Room or from me (if you read this in hard copy there is one attached to the back): Within each week you will have a fixed schedule for ICS & SDL (about 3+ hrs./day), Clinical Procedures, meals & sleep, exercise, board review sessions (when scheduled and attendance intended)--whatever you need to do daily. You can put all, some or none of this on a calendar/schedule, but what you do want to do is to have your study schedule mapped out leaving enough time to take care of these 6 necessities. By the way, it can be a good idea to set aside phone time and let your friends/ family know when so that you can look forward to that time and not find it an interruption to your study concentration. 3. As mentioned earlier, plan to begin each discipline/system with a look-over of the relevant high-yield topics in First Aid (& Step Up ) and the Class of 2006's Survey in the discipline/system you are about to review—>so that when you begin your review you will be able to recognize what might be “high yield” and therefore worth extra effort/time as you review in your review book(s). It is generally not recommended that First Aid , Step up and the “Survey” be used in place of review books ( as these sources are presented as condensed pieces of a system’s or discipline’s edifice rather than as the reconstruction of that edifice); Pharm may be the exception. Some pieces in First Aid present some mnemonics and charts and diagrams which can be quite helpful. 5. Keep a notebook/ First Aid/Step Up handy throughout to jot down topics or facts you judge need more time than the amount of time you have planned will allow. This permits you to keep moving on, keeping close to your plan’s schedule and avoiding getting tied up; practically speaking, remember that, for example, facts like `intracellular fluid is 2/3 of total body weight’ will never be worth more than 1 point on the boards, and might not be on the boards at all, whereas the ‘6 complications of atherosclerosis’ have multiple discipline connections (read, ‘multiple point score possibilities’) and are thus worth more time and effort. ((In the scheme of things, how much time is a factoid worth? –>gotta move on!)). Your plan reminds you to move on, and your notebook or notes added to First Aid assures your doing so safely. It can be helpful to remember that you will not be expected to be a Nephrologist or a Cardiologist or an Immunologist, etc. at this level of your education! 6. As you work your way through each of your review books, you will recognize the high yield info (from First Aid and the Surveys) and can place extra effort/time on it relative to the rest of the review. When you finish a discipline’s/system’s review, schedule time to go back through First Aid (& Step-Up and the ‘Survey’) to be sure you covered all of the high yield info for that discipline; look up elsewhere anything ‘high yield’ you need to know but didn’t find in your review book (No single review book is perfect!). 7. In First Aid you will notice a section of “High-Yield Clinical Vignettes” at the beginning of each discipline. These reflect the kinds of presentations Step 1 might give you on your computerized exam, and thus are useful for testing your knowledge and thinking processes relevant to the discipline you just reviewed.. This is a good tool to use after your review of that discipline and before you test yourself with, for example, Q-Bank. It is also a useful study tool for study with classmates. Schedule time to do some practice questions after each chapter to work with and reinforce what you just reviewed.(20-30 questions should suffice in most cases) You can 8. 7 find such questions at the end of your chapters in BRS, or in PreTest, Q-Bank, or use a test from one of the folders in the Book Room file drawers. Then, as noted in #2..... 9. ...take a comprehensive exam in Q-Bank (or at the end of BRS or in A&L or NMS-- or BSS for systems) after a completed discipline/system review, record your score , and at least go over the explanations for all questions you were uncertain of or got incorrect. Add to your First Aid./Step Up as the explanations reveal holes in your knowledge or things you might worry about forgetting; this will free up your mind to move on to new areas. By keeping a record of your scores you will be able to return to those lower scoring disciplines/systems later if time permits. Some scores carry more weight (Path is usually #1, then Pharm, Micro/Immuno, Behavioral and Physio). As far as systems go, there was no consistently strong pattern in 2004; what was high yield for one was not for another (see Survey). Sequence of Disciplines Some more choices are necessary... Generally students do Anatomy (gross-histo/cell bio-embryo-neuro) and Biochem first; the last 2 are usually Physio & Path, & some fill-in of Genetics after Path PHARM (the 2nd “heavie”) requires some special thought/decision-making-- as noted above under general considerations: >Micro & Pharm, being large rote memory areas, would be remembered best with a minimal outside info load between your study of them and taking the boards. So doing micro just before physio & path works well for many. As noted earlier, Pharm is too big to save & has to be spread out, though general pharm can be done anytime. Don’t forget to schedule a comprehensive pharm exam after finishing Pathology (Discipline approach) or your last system (SA approach); of course, continue to schedule a later pharm re-review. REVIEW SESSIONS & ADDITIONAL SEQUENCING CONSIDERATIONS: Consider attendance at review sessions as part of your review time. Reading over Biochem notes prior to those reviews, then attending the reviews, doing some metabolic topic review questions after each section (e.g., after carbs) and going over First Aid and taking a practice comprehensive biochem exam is all many students do for biochemistry. Biochem review sessions time will total close to 10 hours (relax--over a few days!). If you plan to attend the Biochem review sessions you (almost) must have looked over, for e.g., lipids, before the review presentation on lipids. Most try to save Path reviews ‘til near the end of the review period since it is generally more effective to review normal processes before the pathological Again, it makes sense to review physiology before path, and drug mechanisms as a part of 8 pathophysiology. Behavioral Science (psych and biostat/epi, ethics & Dr-Pt) is likely a lower intensity review for most (requires less ‘hard drive’), and because it is relatively unique it might best be used as a cognitive `break’ when you feel like you are beginning to overdose on basic science info...usually after anatomy and biochem or after path. Considering all 4 areas of Behavioral, it is a significant weight on Step 1, but each of the 4 parts can be reviewed in isolation from the others, and thus, as with General Pharm, can be used as ‘cognitive breaks’ for a day or 2 throughout your review. Don’t forget to take the comprehensive behavioral after the 4th part is reviewed. Path is a keystone- an integrator- for the boards, and as such is well worth the time you can give it. A useful way to bolster your Path is to add a couple of hours of practice questions after each system using questions from among: Q-Bank / Utah WebPath >http://wwwmedlib.med.utah.edu/WebPath/webpath.html< Robbins Review, as well as the end-ofchapter questions in BRS. Blackwell’s Underground Clinical Vignettes in Pathophysiology (3 small volumes)can also be of great assistance in this heavily weighted path area, and, as was noted, is a tool productively used in an interactive setting with one or more classmates. Don’t forget to do some pharm questions with each path system review (e.g., Q-Bank Cardiopharm with Cardiopath). Genetics is not presented as a discipline in First Aid (or among the 1991 NBME Retired Exams).. Most of genetics will have been covered in your biochem, path, & micro reviews. Many students will therefore most efficiently save genetics for last. After all the discipline reviews are ended, pick up a genetics review book (say the newest NMS Genetics), look over the Table of Contents and identify areas you recognize you haven’t reviewed (e.g. population genetics or genetic counseling), review those sections, then take a comprehensive genetics exam on Q-Bank and the PreTest Biochemistry & Genetics also has some useful topical practice questions you can choose from the Table of Contents. Remember to add hi-yield knowledge you might worry about forgetting to your notebook/First Aid. Here is a SAMPLE 10-week schedule for discipline-based review:
(Note: although time off is not included in this schedule, consider setting aside the equivalent of a day each week for your self...you might take a whole weekend day off, or Friday night, Saturday afternoon and Sunday morning, etc. Also, scheduled exercise time can be a big aid to reduce tension...makes energy level more manageable internally) Days 1-6: Biochem (perhaps in concert with the review sessions) Day 7: Q-Bank or/& A & L Step 1 Biochem exam; Days 8-14: Anatomy (1-2 days neuro, 3 days gross(incl. 1 on extremities), 1 day cell bio, 1 day 9 embryo + Review sessions) with First Aid and our student Survey. (note: consider planning to incorporate histo pictures with your path (histopath) review later) Day 15: Q-Bank or A & L Step 1 Anatomy exam; Days 16-20: Behavioral Science + CNS Pharm (3 days psych/1 day pharm, 1 day biostat/epi) (ethics & Dr/Pt. adequately covered in the BRS Comprehensive Exam at the back of BRS. Day 21: Q-Bank Behavioral &/or BRS Comprehensive if not done before Days 22-24: Immuno + relevant pharm (Consider adding General Pharm review , say an hour or 2 during days 25-33) Day 25: Q-Bank &/or Levinson’s (or PreTest Micro’s) Immuno exam Days 26 -32: Micro (Bugs ‘n Drugs) Day 33: Q-Bank’s &/or Levenson’s or A & L Step 1 Micro exam Days 34-39: Physiology Day 40: Q-Bank &/or BRS Comprehensive Physio exam (additional good MCQs from the nonK-Type questions in the Retired 1991 NBME Physio exam) Days 41- 54: Pathology + pharm by organ; alternate days between WebPath, Robbins MCQs & your (BRS) review book; you can add histo pictures (Wheater’s or WebPath, etc) along-side histopath, though it is not necessary. Day 55-56: Underground Clinical Vignettes & First Aid Path review Day 57: Comprehensive Path exam: BRS, Q-Bank. Day 58: Review Pharm Day 59: Comprehensive Pharm exam (Q-Bank, A&L, Katzung) This would be a day also to take a second CBSSA if you have concerns about your readiness for your test day over a week away (need a week+ remaining if you need to change your date). Take it timed. Use the score to see what kind of score you would have were you to take Step 1 that day, and use the profile to focus your review in the last week the most productively) Day 60: review Genetics not covered to date, then take comprehensive genetics practice test in Q-Bank, &/or in PreTest. Note: now is a good time to look over your recorded discipline scores; ideally, you will want all Q-Bank scores to be 65% or higher ; if any are below that level, especially Path, Pharm or Micro, you will want to schedule some extra time in the last week or so to re-review topics from your weakest discipline(s). Note: it is normally not useful to “score” your practice tests during the last week or 2 before your scheduled USMLE day...scoring then is most likely to leave you with either diminished or excessive confidence, and in any case, there is not much you can do about the score this late in the game; rather, consider using the test for practice and filling in holes in your knowledge. Days 60-63: plan a portion of each day to review your notes & First Aid & Survey, & plan another portion of each day to take Organ/System practice tests such as found in Board Simulator Series (BSS) or Q-Bank. This will give you practice integrating the disciplines. Remember, BSS tests are typically much more difficult than the real Step 1 exam. Days 64-66: Continue reviewing First Aid in the morning, and schedule a mock/integrated board exam each day; this will integrate the organ systems, start a warm-up for the real Step 1 just days away, fill in knowledge holes, etc. There are excellent mock exams to test content in Lazo’s 10 NMS Review for USMLE Step 1, or use the comprehensive exams in King’s Appleton & Lange’s Review for USMLE Step 1, or Blackwell’s Blueprints Step 1 Q & A (all in Book Room files), or Q-Bank of course..If you need more, there are also practice tests in J&S’s “Rapid Preparation for the USMLE Step 1" (used by Princeton Review). Days 67-68: First do the Step 1 tutorial on the NBME/USMLE Web Site; you should know the keystrokes well from this or Q-Banl before you go to the Testing Center-- so you can use that testing center time for other things (like an extra or a longer break!). Along with the tutorial are 150 Sample questions in blocks of 50 which are excellent samples of the real test questions (you may actually see 1 or 2 on the real test) and which you can use to both practice the keystrokes and your timing, as well as to continue filling in knowledge holes. Do these questions in blocks of 50....you will want to finish each set of 50 questions in an hour or less, as you will be training your nervous system to let you know when it senses you have spent enough time on a question...so you can put down an answer, mark it as a question you may return to (time permitting), and move on. If you do these practice questions too far out from your testing day, your nervous system will not retain this “timing memory”( the USMLE does not give explanations, so look for explanations either on the Kaplan Web Site or in the Book Room files if the questions are the same as last year). Continue reviewing your notes/ First Aid, pharm cards... whatever rote material you have needing re-exposure. Day 69: (see # 1 below in “General Motivational Thoughts” General Thoughts 1. It is normally best to take the day before your testing day off...or at least as much of the day off as you can bear! Remember, this is a very broad-based exam, and whatever you look at just prior to the exam will tend to be held in a ‘short-term memory deposit box’ which will stand ready to look for useful matches with its contents during the testing day, especially in the first Block. Rather than ‘looking for’ info in your test you want to be as receptive as possible to what is actually presented; it is quite possible that nothing you look at the day before your exam will appear on your test, so why waste memory space when you want as much as possible of your receptive consciousness available. 2. Depending upon the competitiveness of the residency you will want to enter, establish your acceptable criterion; in any case, aim high, as it will increase your possibilities (and it gives you a safety cushion!). And don’t forget that your score will, to a degree, be reflected in the school’s performance; the better the school performs, the higher the stature of the school, the greater the school’s reputationthe greater the contribution to your future career choices. 3. Since Path, Micro and Pharm are the “heavies”, if 1 or more of these 3 scores are below your acceptable criterion, or are among the relative lowest of your recorded scores, consider taking additional discipline-based practice exams in that discipline(s). The comprehensive discipline exams in the back of BRS. or NMS, or/and the comprehensive discipline exam(s) in Appleton & Lange’s Review for USMLE Step 1 (as well as Q-Bank) are useful if you haven’t used them yet for that discipline; if you can identify major topics within a discipline that are your weakness, Q- 11 Bank & PreTest in that discipline will give you whole sections of topical questions. 4. If you start to experience “Burnout” (i.e., when you sit down to study you feel an overwhelming resistance, if not revulsion, towards the work in front of you, and almost nothing “sticks”) you need to take a real break. Take a day off and do everything you like to do and try not to think about the boards. It is useless to feel guilty during such a break because you wouldn’t be productive studying anyway! (If you can’t think of anything you want to do, how about exercise??) I will be here to help you in any way I can. Take care of each other! 12 ...
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- Spring '08
- Pharm, USMLE Step 1